2007 Model Practice Application (Public)

Birth Certificate Lead Poisoning Prevention Program

Rock County Health Department

Birth Certificate Lead Poisoning Prevention Program targets families with infants 6 months of age and addresses the issue of lead poisoning prevention. The goal of the program is to reduce the number of childhood lead poisoning cases through primary prevention strategies such as educating at risk families on lead poisoning prevention and preventing children living in at risk environments from becoming lead poisoned. This goal is reached by the following objectives:

• Review Birth Certificates (BC’s) to identify infants at 6 months of age who reside in pre-1950 housing.
  
  
• Contact parents to schedule a home visit.
  
  
• Provide education about lead poisoning & prevention.
  
  
• Provide information to families who decline home visit.
  
  
• Provide follow-up services as requested by parents.
  
  
• Provide an environmental assessment to identify lead hazards.
  
  
• Provide strategies to prevent exposure from lead hazards.
  
  
• Provide information on adequate nutrition.
  
  
• Encourage blood lead level testing of children by 1 year of age.
  
  
• Offer lead testing of siblings who have not been tested.
  
  
• Provide lead hazard mitigation recommendations to home owners & landlords.
  
  
• Provide lead hazard mitigation follow-up services as needed.

The program has provided 2249 at risk families educational material and 913 families have had educational home visits/assessments. Since the initiation of the program there has been a gradual decrease in lead poisoning cases, with the number of reportable cases decreasing an average of 13.4% per year and a 73% decrease in reported cases in 2005 compared to 1997. The cost associated with the damage lead poisoning can cause a young child goes beyond initial medical treatment. The Wisconsin Department of Health and Family Services estimates, based on scientific literature, that the average minimum health benefit a child would receive by avoiding lead poisoning is $45, 608. Based on the Health Department averaging 101 lead poisoning cases per year for the five years preceding the program, an estimated savings of $302,000 (2007 dollars) each year.

In the early 1990’s, the Rock County Health Department began receiving referrals on children with blood lead levels of >20 ug/dL. In succeeding years, as more information became available about the significance of lead poisoning and the affects on childhood development, and as the number of lead poisoned children increased, Rock County Health Department Officials became more proactive in efforts to prevent lead poisoning. Working with the medical community and other agencies involved in childhood blood level testing, Rock County developed a system to receive notification of all blood lead levels >10 ug/dL as opposed to the mandatory reporting of levels >20 ug/dL. All reported cases were investigated and followed until contributing properties were made lead safe and blood lead levels reached acceptable levels. Although this strategy helped to reduce the number of lead poisoning cases at the reportable level, Rock County continued to investigate ways to prevent the disease through primary prevention measures. By identifying at risk children early, the agency felt lead poisoning or even lead exposure could be prevented in many cases. Targeting families with young children who lived in housing likely to contain lead based paint was determined to be the best approach. By using birth certificate information and comparing it with the existing knowledge of when homes in the county were built, the Health Department had a way of identifying a large section of the at risk population. This practice not only provides the means of educating at risk families on lead poisoning prevention, but also the opportunity to identify and to mitigate lead hazards before damage is done.

Prior to the start of the program, review of existing literature and consultation with the State of Wisconsin Lead Poisoning Prevention Program, found that existing lead prevention programs mainly focused on managing cases of existing lead poisoned children. Primary prevention strategies were limited to broad public education and lead hazard reduction home rehabilitation programs. Existing programs had success at bringing lead poisoning cases to acceptable levels, but had only a minimal impact on prevention. Although there was a surplus of educational material available, no system was in place to ensure the highest risk families received it. Since previous childhood lead poisoning cases were mainly coming from pre-1950 housing, it was determined that a system was needed to target these high risk families. Research indicated that birth certificates were the best and most comprehensive data source that identified families with young children in the county. Comparing the home addresses on the certificates with existing housing data, a large part of the high risk population could be identified and educated.

The Rock County Health Department initiated this practice by identifying the target population through birth certificate and housing information. The department’s public health nurses conduct the initial outreach and education for the high risk families. The nurses work with the family’s physician to encourage regular testing of children in high risk environments. The Health Department provides Certified Lead Risk Assessors who work with families and landlords to identify and mitigate lead hazards in the home. The Lead Risk Assessors also provide information on and referrals to local lead hazard reduction programs that help with the financial burden of lead abatement throughout the county. The Health Department works closely with several agencies that provide financial assistance to homeowners who desire long term lead hazard solutions. The Health Department is also one of the lead agencies in the newly founded (2007) Health Homes – Healthy Kids Lead Hazard Control Program, which received a $1.1 million HUD grant to remove lead paint hazards from high risk homes in Rock County.

Funding for this program came from a state grant and local tax dollars. Costs related to staff time and educational materials estimated at $66,720 annually.

Birth Certificates are reviewed retrospectively to identify infants who were born about 6 months ago and whose home address is located in an area where the housing was generally built before 1950. Public Health Nurses contact families who meet the above criteria within one month, either by phone or letter. Families are offered an educational home visit by a nurse to provide more detailed information on childhood lead poisoning prevention. If a family declines a home visit, informational pamphlets are mailed to the family and an offer is made to visit in the future if the family desires. If the family accepts a home visit, the nurse provides information regarding lead poisoning and prevention. Topics include how children are exposed, the role of nutrition, common lead hazards, and testing information. The nurse also conducts a cursory assessment with Lead Checks in areas of the home where infants/children spend significant time. If there are other children in the home who have not been tested, the parents are encouraged to have the children tested by a physician or through Health Department resources. If lead hazards are identified the family is offered a comprehensive environmental assessment conducted by a Certified Lead Risk Assessor. If the family accepts the assessment, the Lead Risk Assessor evaluates and tests all surfaces inside and outside the home to identify lead based paint hazards and non-lead based paint hazards. A report detailing the investigation findings and recommendations on eliminating/reducing the identified lead hazards is sent to the family and, if applicable, to the landlord. The lead hazard control recommendations consist of short-term cost-effective techniques that can be quickly implemented and also more permanent long-term solutions. The lead risk assessor will work with the family and, if applicable, the landlord to ensure lead hazards are addressed in a timely and lead safe manner. Homeowners and landlords will also be given information and guidance on available local resources that can help offset the cost of more permanent lead hazard control measures.

The Birth Certificate Lead Poisoning Prevention Program has been and should continue to be very sustainable. Because of the success of preventing lead poisoning and the value to the health of the children the program serves, local tax dollars and state funding continues to support the program. The cost to run the program involves mostly staff time and a minimal amount set aside for educational material. The cost for the nursing staff time for the service is estimated to be $38 per hour of service. The cost for environmental health staff time is estimated to be $35 per hour of service. Since this program reduces the number of lead poisoned children and lead poisoning cases generally occupy a significantly greater amount of staff time than the birth certificate visits, the addition of this program has had little impact on overall staff time devoted to lead poisoning prevention. The program was expanded in 2006 to include the city of Beloit, which had maintained its own Health Department until merging with the Rock County. The Beloit Health Department lead prevention program generally had included only cases at reportable blood lead levels. The City of Beloit has a very high number of houses built before 1950 and a high number of at risk children live in these homes. It is expected that the inclusion of the City of Beloit will initially cause a significant increase in staff time devoted to this program, but due to additional staff from the merger and the expected decrease in lead poisoned children due to primary prevention, it is fully expected that the program will remain highly manageable and sustainable into the foreseeable future.

The goal of this practice is to reduce the number of childhood lead poisoning cases through primary prevention strategies.

Objective: Educate parents of at risk children on lead poisoning prevention. Performance Measures: Yearly goal to have 40% of at risk families identified through the birth certificate process accept an educational home visit. Outcome: Since the program inception 84% of target families accepted some level of education. 34% of targeted families accepted home visits. The number of lead poisoning cases per year has steadily declined, with the number of reportable cases decreasing an average of 13.4% per year and a 73% decrease in reported cases in 2005 compared to 1997.

Feedback: Management reviews all data.Selling the importance of lead poisoning prevention has been a challenge to obtain the desired outcomes. Many targeted families struggle finanically and put this issue low on the priority list. The use of incentives and flexible approaches of selling have been implemented to deal with this issue.A recent challenge has been with the growing number of non-enlish speaking families. The use of interpretors has helped to offset this challenge.